By Randy Dotinga

Under fire from MD or DO anesthesiologists who claim their job title is being misappropriated, the American Association of Nurse Anesthesiology (AANA) has withdrawn applications to register trademarks for two variations on its name.

The AANA will keep using its revised name, however, keeping alive the battle over whether the clinicians long known as “nurse anesthetists” can rebrand themselves as “nurse anesthesiologists.”

Here’s what you need to know about this ongoing dispute.

What Is This Fight About?

Who gets to call themselves anesthesiologists? Physicians only? Or nurses too?

Until recently, American medical doctors claimed the terms “anesthesiology” and “anesthesiologist,” while nurses who provided anesthesia were known as certified registered nurse anesthetists (CRNAs).

In 2021, the organization then known as the American Association of Nurse Anesthetists renamed itself the AANA in a bid to clarify “the role of CRNAs/nurse anesthesiologists as advanced practice registered nurses who are experts in the science and art of anesthesiology.”

How Did That Go Over?

Physician organizations quickly criticized the move. The American Society of Anesthesiologists (ASA) accused the nurses of “misappropriation” and declared that “since its first use in 1922, ‘anesthesiologist’ has always referred to physicians trained in the medical science of anesthesiology.”

“It’s as if a nurse was using the term ‘nurse surgeon’ or ‘nurse gastroenterologist,’” said Houston anesthesiologist Patrick Giam, MD, president of the ASA. “It’s a fundamental right for patients to know who’s taking care of them.”

How Do These Clinicians Differ?

They differ in education requirements and salaries, with physicians requiring more schooling and making more money.

In some states, nurses who provide anesthesia must be supervised by physicians, but they are independent in other states. There are also state-by-state variations in their right to prescribe medication.

Some states have expanded the scope of practice of nurses who provide anesthesia, but the moves have been hotly debated.

What Happens Now?

The AANA has a registered trademark for its name per the 2021 rebranding. According to the association, it had also filed registered trademarks for two related names:

- The American Association of Nurse Anesthesiologists

- The American Association of Nurse Anesthetists and Nurse Anesthesiologists

The association says it intended to use the name for “potential future AANA business entities.”

The ASA challenged the trademark registration requests in 2024, arguing that the names are “deceptive” because anesthesiologists are physicians by definition.

On June 29, the AANA decided to withdraw its trademark applications for the two names.

“AANA made a voluntary decision that has no impact on what CRNAs are called, how we practice, or the qualifications we bring to patient care,” said Jeff Molter, MSN, MBA, CRNA, the association’s president, in a statement.

“CRNAs can continue to accurately describe their role as nurse anesthesiologists, nurse anesthetists, or CRNAs, consistent with applicable state law,” Molter said. “Patients can continue to rely on CRNAs for safe, high-quality anesthesia care in every setting, and that is where our focus remains.”

Why Did AANA Decide Not to Pursue These Trademarks?

AANA said in a statement that it made a “responsible fiduciary decision” but otherwise declined to elaborate on the move.

“I would not be surprised if the parties reached some off-the-record resolution,” said Kayla Jimenez, JD, intellectual property attorney and adjunct law professor at the University of San Diego in San Diego.

But AANA Is Keeping Its Name?

Yes, it will continue to be called the AANA.

“AANA’s current name is not at issue here,” spokeswoman Nicole Ryan said, because it is already trademarked.

What Do the Physician Anesthesiologists Think of All This?

Giam said that “it’s really a big positive win for patients in truth and transparency in medical titles.”

Are the Anesthesiologists Going to Sue Over the AANA’s Name?

“Our efforts are to promote accuracy, transparency, and appropriate titles in a variety of settings,” Giam said. “We’re considering a lot of things, and we haven’t taken any options off the table.”

The legal wrangling likely isn’t over yet, said Eric Goldman, JD, MBA, professor and associate dean for research at Santa Clara University School of Law in Santa Clara, California.

“There will need to be some legal resolution about whether it’s more accurate to refer to the professionals in question as ‘anesthetists’ or ‘anesthesiologists,’” he said.

Among other things, consumers need clarity so they can make sure they are getting the services they need and expect. There is also a lot of money at stake. I expect the resolution will take place through some legal mechanism beyond trademark law.

“For the sake of the patients,” he added, “I hope the resolution happens soon.”